Reducing Adolescents’ Risky Behaviors

    • April 9, 2014

Three new studies by Robert Wood Johnson Foundation (RWJF) scholars examine distinct aspects of adolescent and young adult health. Two of the studies, one by Aletha Akers, MD, MPH, of Magee-Womens Hospital in Pittsburgh and another by Julie Maslowsky, PhD, a postdoctoral fellow at the University of Wisconsin, are aimed at understanding and reducing harmful behaviors by teens and young adults. An additional study by Maslowsky examines the sleep habits of adolescents and young adults with an eye toward how sleep relates to substance abuse and mental health problems.

An RWJF Health & Society Scholar (2012-14), Maslowsky worked with several colleagues to gauge the sleep habits—by gender, race, age group, and ethnicity—of teens and young adults. Using data from the National Longitudinal Study of Adolescent Health (Add Health), the research team tracked more than 15,000 teens as they grew into young adulthood. As people moved through different stages of life, the team found that sleep duration varied: Study participants averaged 8.5 hours of sleep a night at age 13, 7.3 hours at age 18, 8.5 hours at age 22, and 7.7 hours at age 32.

Adolescent girls tended to get less sleep than boys, but once they reached age 19, that trend reversed. Short sleep duration—less than six hours a night—was most common among Black survey participants at all ages. But while some Black survey respondents got too little sleep, others got too much, with Blacks and Hispanics also overrepresented in the group of teens and young adults who got more sleep than recommended—more than 10 hours a night. 

As Maslowsky observes, “Getting too little or too much sleep is related to a number of mental and physical health problems. That includes depression, anxiety, cardiovascular disease, and diabetes. We know there are disparities in numbers and outcomes by race, so these findings indicate that disparities in sleep could relate to disparities in health outcomes.” Her article on the study is forthcoming in the Journal of Adolescent Health.

Maslowsky’s interest in the sleep habits of teens and young adults grew out of her research on mental health and substance abuse. “Sleep might tie mental health and substance abuse together,” she says. “It is important to understand how sleep problems relate to risky health behavior.”

Early Mental Health Problems a Key to Later Substance Abuse?

In a separate study, this one published in the November 2013 issue of Developmental Psychology, Maslowsky and colleagues examine the effect of adolescents’ mental health problems on their subsequent drug and alcohol abuse. Using early 1990s data from the “Monitoring the Future” study, that team followed 6,000 eighth-grade students as they matured over four years.

The data confirmed previous research that found a relationship between mental health problems and substance abuse. It also produced a comparatively new finding: Teens of 12th-grade-age are more likely to have substance abuse problems if they exhibited mental health issues in eighth grade than if they exhibited them in 10th grade. As Maslowsky and her colleagues write, “Overall, the results indicate that early-emerging mental health problems have a stronger influence on adolescent substance use than later-emerging symptoms, even when the early-emerging symptoms are relatively distal from the substance use outcome.”

“What this indicates,” Maslowsky says, “is that if you’re a school district and you have to choose when to implement a mental health-based substance use prevention program with your students, you’d do better to look at eighth grade, making sure you address it early on. That’s true even though the prevalence of substance use is lower at that age than among slightly older teens. What is happening by eighth grade is most predictive of what will happen later on.”

Counseling by Health Care Providers

In a third youth-focused study, Akers, an alumna of the Harold Amos Medical Faculty Development Program (2009-13) considered another aspect of adolescent risk behavior: the counseling that pediatric health care providers give to parents about preventing dangerous behavior by their adolescent children.

Akers and colleagues administered a questionnaire to 358 parents accompanying their 11- to 18-year-old children to two outpatient clinics, asking which, if any, of 22 prevention topics their children’s health care providers discussed with them. More than 80 percent of the parents reported discussing at least one of the 22 topics; however, the topics most frequently cited were those that account for the least adolescent morbidity—physical exercise and nutrition, for example. The topics the parents least frequently recalled discussing were those related to the highest mortality rates, including sexually transmitted diseases, substance abuse, and mental health problems.

“Most adolescent morbidity is due to risky behaviors,” Akers explains. “So screening and counseling is important.” That is also why we have “guidelines that say providers should talk to parents,” she says. “Since providers don’t see adolescents very often, it’s important to deliver messages to parents, too, because parents have an opportunity to ensure their adolescent’s health on an ongoing basis.”

Akers cautions that because the data is based on parents’ recollection, it is possible that some topics were discussed but parents simply did not absorb the information or filtered it out of their recollections. “I don’t think the takeaway from the study is that providers need to talk more. In my own clinical work, I see that even if kids aren’t engaging in sex or drug use, their parents may be very concerned that they will be soon, because of the neighborhood environment they live in. And they’re probably right to worry. So providers need to be strategic, understand what each family may need, and then provide tailored messages that will have the greatest effect for individual families, if we’re going to move the numbers.” Akers’ study was published in the February 2014 issue of Patient Education and Counseling.


Related Websites

Read Maslowsky’s sleep study, and her study on the relationship between mental health and substance abuse problems.

Read Akers’ study on counseling.

Learn more about the RWJF Health & Society Scholars program.

Learn more about the Harold Amos Medical Faculty Development Program.

For an overview of RWJF scholar and fellow opportunities, visit